Physioedge, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PHYSIOEDGE, LLC

Practice address

670 North Ave NW
Suite 201
Marietta, GA 30060-1100

Phone

(770) 792-8081

Fax

(770) 792-8083

NPI assigned

Mar 6, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Al Wynne Querubin Gesite, P.T.NPI 1801066790

Title

Owner

Phone

(404) 771-0554

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Al Wynne Querubin Gesite, P.T.

  • Physical Therapist
  • Marietta, GA
  • NPI 1801066790
  Medicare reassignment Care Compare group NPD Authorized official
• Zachary Paul Dunkle, DPT

  • Physical Therapist
  • Atlanta, GA
  • NPI 1154754059
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332460800000",
    "number": "1982874863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 MILLSTONE PKWY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301886139",
            "telephone_number": "404-771-0554",
            "fax_number": "770-792-8083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 NORTH AVE NW",
            "address_2": "SUITE 201",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601100",
            "telephone_number": "770-792-8081",
            "fax_number": "770-792-8083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIOEDGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-06",
        "last_updated": "2012-03-23",
        "status": "A",
        "authorized_official_last_name": "GESITE",
        "authorized_official_first_name": "AL WYNNE",
        "authorized_official_middle_name": "QUERUBIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-771-0554",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Physical Medicine Center
• Physical Therapy Consultants Inc
• Physical Therapy Partners of Georgia, LLC
• Physicans at Home, LLC
• Physicians Spine and Rehab Specialists of Ga
• Physiotherapy Associates Inc
• Jaclyn Miller Piasta, DNP, APRN, WHNP-BC
• Lauren Taylor Pichardo
• Danielle Pichette, D.C.
• Madison Pickens, LMSW

• Physical Therapy Clinic/Center in Marietta, GA
• Providers in Marietta, GA by specialty
• Physical Therapy Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.